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Naik S, Lepine S, Nagels HE, Siristatidis CS, Kroon B, McDowell S. Androgens (dehydroepiandrosterone or testosterone) for women undergoing assisted reproduction. Cochrane Database Syst Rev 2024; 6:CD009749. [PMID: 38837771 PMCID: PMC11152211 DOI: 10.1002/14651858.cd009749.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Practitioners in the field of assisted reproductive technology (ART) continually seek alternative or adjunct treatments to improve ART outcomes. This Cochrane review investigates the adjunct use of synthetic versions of two naturally produced hormones, dehydroepiandrosterone (DHEA) and testosterone (T), in assisted reproduction. Steroid hormones are proposed to increase conception rates by positively affecting follicular response to gonadotrophin stimulation. This may lead to a greater oocyte yield and, subsequently, an increased chance of pregnancy. OBJECTIVES To assess the effectiveness and safety of DHEA and T as pre- or co-treatments in infertile women undergoing assisted reproduction. SEARCH METHODS We searched the following electronic databases up to 8 January 2024: the Gynaecology and Fertility Group (CGF) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries for ongoing trials. We also searched citation indexes, Web of Science, PubMed, and OpenGrey. We searched the reference lists of relevant studies and contacted experts in the field for any additional trials. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing DHEA or T as an adjunct treatment to any other active intervention, placebo, or no treatment in women undergoing assisted reproduction. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted relevant data, and assessed risk of bias. We pooled data from studies using fixed-effect models. We calculated odds ratios (ORs) for each dichotomous outcome. Analyses were stratified by type of treatment. We assessed the certainty of evidence for the main findings using GRADE methods. MAIN RESULTS We included 29 RCTs. There were 1599 women in the intervention group and 1469 in the control group. Apart from three trials, the trial participants were women identified as 'poor responders' to standard in vitro fertilisation (IVF) protocols. The included trials compared either T or DHEA treatment with placebo or no treatment. Pre-treatment with DHEA versus placebo/no treatment: DHEA likely results in little to no difference in live birth/ongoing pregnancy rates (OR 1.30, 95% confidence interval (CI) 0.95 to 1.76; I² = 16%, 9 RCTs, N = 1433, moderate certainty evidence). This suggests that in women with a 12% chance of live birth/ongoing pregnancy with placebo or no treatment, the live birth/ongoing pregnancy rate in women using DHEA will be between 12% and 20%. DHEA likely does not decrease miscarriage rates (OR 0.85, 95% CI 0.53 to 1.37; I² = 0%, 10 RCTs, N =1601, moderate certainty evidence). DHEA likely results in little to no difference in clinical pregnancy rates (OR 1.18, 95% CI 0.93 to 1.49; I² = 0%, 13 RCTs, N = 1886, moderate certainty evidence). This suggests that in women with a 17% chance of clinical pregnancy with placebo or no treatment, the clinical pregnancy rate in women using DHEA will be between 16% and 24%. We are very uncertain about the effect of DHEA on multiple pregnancy (OR 3.05, 95% CI 0.47 to 19.66; 7 RCTs, N = 463, very low certainty evidence). Pre-treatment with T versus placebo/no treatment: T likely improves live birth rates (OR 2.53, 95% CI 1.61 to 3.99; I² = 0%, 8 RCTs, N = 716, moderate certainty evidence). This suggests that in women with a 10% chance of live birth with placebo or no treatment, the live birth rate in women using T will be between 15% and 30%. T likely does not decrease miscarriage rates (OR 1.63, 95% CI 0.76 to 3.51; I² = 0%, 9 RCTs, N = 755, moderate certainty evidence). T likely increases clinical pregnancy rates (OR 2.17, 95% CI 1.54 to 3.06; I² = 0%, 13 RCTs, N = 1152, moderate certainty evidence). This suggests that in women with a 12% chance of clinical pregnancy with placebo or no treatment, the clinical pregnancy rate in women using T will be between 17% and 29%. We are very uncertain about the effect of T on multiple pregnancy (OR 2.56, 95% CI 0.59 to 11.20; 5 RCTs, N = 449, very low certainty evidence). We are uncertain about the effect of T versus oestradiol or T versus oestradiol + oral contraceptive pills. The certainty of the evidence was moderate to very low, the main limitations being lack of blinding in the included trials, inadequate reporting of study methods, and low event and sample sizes in the trials. Data on adverse events were sparse; any reported events were minor. AUTHORS' CONCLUSIONS Pre-treatment with T likely improves, and pre-treatment with DHEA likely results in little to no difference, in live birth and clinical pregnancy rates in women undergoing IVF who have been identified as poor responders. DHEA and T probably do not decrease miscarriage rates in women under IVF treatment. The effects of DHEA and T on multiple pregnancy are uncertain. Data regarding adverse events were very limited; any reported events were minor. Research is needed to identify the optimal duration of treatment with T. Future studies should include data collection on adverse events and multiple pregnancy.
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Affiliation(s)
- Sandeep Naik
- Obstetrics and Gynaecology, Capital Coast District Heath Board, Wellington, New Zealand
| | - Sam Lepine
- Department of Obstetrics and Gynaecology, Capital and Coast District Health Board, Wellington, New Zealand
| | - Helen E Nagels
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charalampos S Siristatidis
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ben Kroon
- Queensland Fertility Group Research Foundation, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Simon McDowell
- Obstetrics and Gynaecology, Capital Coast District Heath Board, Wellington, New Zealand
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Lass A, Lass G. Inequalities in assisted reproduction technology utilisation between the G20 countries. HUM FERTIL 2023; 26:1374-1379. [PMID: 34915790 DOI: 10.1080/14647273.2021.2017025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
Large global inequalities in assisted reproduction technology (ART) utilisation have existed ever since the introduction of ART. The reasons for these inequalities are multifactorial and include national wealth and affordability, pronatalist policies, regulatory differences in provision, and sociocultural components such as racial, gender and educational inequalities. Examining ART utilisation across the largest world economies (G20 countries) in 2016 (the most recent year with publically available data) reveals significant inequality, which is highly correlated to gross domestic product per capita, a measure of national wealth, and to provision of government funding and/or insurance coverage for in vitro fertilisation and intracytoplasmic sperm injection. A strong negative correlation with the Gender Inequality Index is also noted. The gap in ART utilisation rate will only begin to close once the majority of nations introduce more affordable ART treatment, instigate pronatalist policies, and implement changes in education, attitudes and behaviours to minimise racial and gender inequalities; however, achieving all of these changes may be a very difficult target to attain for many poorer economies, regardless of their size.
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Affiliation(s)
| | - Geffen Lass
- Department of Women and Children's Health, King's College London, London, UK
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Wesselink AK, Hystad P, Kirwa K, Kaufman JD, Willis MD, Wang TR, Szpiro AA, Levy JI, Savitz DA, Rothman KJ, Hatch EE, Wise LA. Air pollution and fecundability in a North American preconception cohort study. ENVIRONMENT INTERNATIONAL 2023; 181:108249. [PMID: 37862861 PMCID: PMC10841991 DOI: 10.1016/j.envint.2023.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Animal and epidemiologic studies indicate that air pollution may adversely affect fertility. However, the level of evidence is limited and specific pollutants driving the association are inconsistent across studies. METHODS We used data from a web-based preconception cohort study of pregnancy planners enrolled during 2013-2019 (Pregnancy Study Online; PRESTO). Eligible participants self-identified as female, were aged 21-45 years, resided in the United States (U.S.) or Canada, and were trying to conceive without fertility treatments. Participants completed a baseline questionnaire and bi-monthly follow-up questionnaires until conception or 12 months. We analyzed data from 8,747 participants (U.S.: 7,304; Canada: 1,443) who had been trying to conceive for < 12 cycles at enrollment. We estimated residential ambient concentrations of particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) using validated spatiotemporal models specific to each country. We fit country-specific proportional probabilities regression models to estimate the association between annual average, menstrual cycle-specific, and preconception average pollutant concentrations with fecundability, the per-cycle probability of conception. We calculated fecundability ratios (FRs) and 95% confidence intervals (CIs) and adjusted for individual- and neighborhood-level confounders. RESULTS In the U.S., the FRs for a 5-µg/m3 increase in annual average, cycle-specific, and preconception average PM2.5 concentrations were 0.94 (95% CI: 0.83, 1.08), 1.00 (95% CI: 0.93, 1.07), and 1.00 (95% CI: 0.93, 1.09), respectively. In Canada, the corresponding FRs were 0.92 (95% CI: 0.74, 1.16), 0.97 (95% CI: 0.87, 1.09), and 0.94 (95% CI: 0.80, 1.09), respectively. Likewise, NO2 and O3 concentrations were not strongly associated with fecundability in either country. CONCLUSIONS Neither annual average, menstrual cycle-specific, nor preconception average exposure to ambient PM2.5, NO2, and O3 were appreciably associated with reduced fecundability in this cohort of pregnancy planners.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States.
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Kipruto Kirwa
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States
| | - Mary D Willis
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States; School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, MA, United States
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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4
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Lazzari E, Tierney K. Parental sociodemographics of medically assisted reproduction births in the United States: a dyadic population-level study. F S Rep 2023; 4:292-299. [PMID: 37692190 PMCID: PMC7615071 DOI: 10.1016/j.xfre.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To study how men's and couples' sociodemographic characteristics predict the probability of having a birth conceived using medically assisted reproduction (MAR) in the United States. Design Population-based study. Setting Not applicable. Patients Men and women in the National Vital Statistics Birth certificate data from 2009 to 2019. Intervention None. Main Outcome Measures Proportion of MAR births out of total births by parental sociodemographic categories and probability of having a MAR birth. Results Between 2009 and 2019, the overall prevalence of MAR births among men was 1.81%. Fathers of children conceived using MAR tended to be older, higher educated, and white compared with fathers of naturally conceived children. During the period of 2009-2019, these sociodemographic profiles remained largely unchanged. Controlling for maternal age and birth order only partially reduced disparities by education and race. In 2019, highly educated fathers were 2.04 percentage points (95% confidence interval, 1.97-2.12) more likely to have a MAR-conceived birth than fathers with a low educational level, and black fathers were associated with a reduction in the probability of having an MAR-conceived child by - 1.07 percentage points (95% confidence interval, -1.11 to -1.04) compared with white fathers. The dyadic analysis using parents' education and race interactions revealed that partnering with someone of a higher educational level increases the likelihood of having a MAR birth, beyond what would be observed by considering only individual-level characteristics. Conclusions To comprehend the environment in which MAR-conceived children are born and raised, performing dyadic analyses that examine the characteristics of both partners is essential. The findings underscore the enduring presence of substantial social disparities in MAR use in the United States, with MAR-conceived children raised in environments of relative advantage, which may impact their future health and development.
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Affiliation(s)
- Ester Lazzari
- Department of Demography, University of Vienna (Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)), Vienna, Austria
| | - Katherine Tierney
- Department of Sociology, Western Michigan University, Kalamazoo, Michigan
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Wang L, Cheng L, Zhang S, Su M, Jin Y, Luo D. Mediation effect of pregnancy-induced hypertension on the association between assisted reproductive technology and adverse neonatal outcomes: a population-based study. BMC Pregnancy Childbirth 2023; 23:385. [PMID: 37231502 DOI: 10.1186/s12884-023-05694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Assisted reproductive technology (ART) has been widely used in the treatment of infertility, and is associated with adverse maternal and neonatal outcomes. However, the potential pathways by which ART affects adverse neonatal outcomes are unclear. We aimed to investigate the role of pregnancy-induced hypertension (PIH) in the association between ART and adverse neonatal outcomes. METHODS Adult women (aged ≥ 18 years) with a singleton pregnancy in the National Vital Statistics System (NVSS) 2020 were enrolled in this retrospective cohort study. Study outcomes were adverse neonatal outcomes, including premature birth, low birth weight, and admission to the neonatal intensive care unit (NICU). Logistic regression models were utilized to investigate the association between ART, PIH, and adverse neonatal outcomes, expressed as odds ratio (OR) and 95% confidence interval (CI). The distribution-of-the-product method was used to explore whether there was a mediating effect of PIH between ART and adverse neonatal outcomes, and the 95% CI of the distribution-of-the-product did not contain 0 indicating a mediating effect. RESULTS This study included 2,824,418 women, of whom 35,020 (1.24%) women used ART, 239,588 (8.48%) women had PIH, and 424,741 (15.04%) neonates had any adverse neonatal outcomes. The use of ART was associated with higher odds of PIH (OR = 1.42; 95%CI: 1.37-1.46) and any adverse neonatal outcomes (OR = 1.47; 95%CI: 1.43-1.51). The distribution-of-the-product was 0.31 (95%CI: 0.28-0.34), and 8.51% of the association between ART and adverse neonatal outcomes was mediated through PIH. Among different adverse neonatal outcomes, PIH mediated 29.17% of the association between ART and low birth weight, 9.37% of the association between ART and premature birth, and 12.20% of the association between ART and NICU admission. The mediating effect of PIH was found in women of different ages (< 35 years and ≥ 35 years) and parities (primipara and multipara). CONCLUSION This study supports a mediating role for PIH in the association between ART and adverse neonatal outcomes. Further studies are needed to determine the mechanisms by which AR affects PIH so that interventions to reduce PIH can be developed to reduce adverse neonatal outcomes associated with ART.
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Affiliation(s)
- Luying Wang
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China
| | - Linbo Cheng
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China
| | - Shimao Zhang
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China
| | - Mi Su
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China
| | - Ying Jin
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China
| | - Dan Luo
- Department of Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 Riyue Avenue, Qingyang District, Chengdu, 611731, P.R. China.
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Huddleston A, Ray K, Bacani R, Staggs J, Anderson RM, Vassar M. Inequities in Medically Assisted Reproduction: a Scoping Review. Reprod Sci 2023:10.1007/s43032-023-01236-6. [PMID: 37099229 PMCID: PMC10132432 DOI: 10.1007/s43032-023-01236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/31/2023] [Indexed: 04/27/2023]
Abstract
Infertility has a high prevalence in the USA and health inequities play a large role in access to medically assisted reproduction (MAR). The aim of this study was to identify gaps in research pertaining to inequities in MAR and propose suggestions for future research directions. Searches were performed using MEDLINE and Ovid Embase. Articles that reported on MAR inequities, published between 2016 and 2021 in the USA, and written in English were included. The inequities investigated were adapted from the NIH-designated health disparities populations. Each article's inequity findings were extracted and reported, along with frequencies of inequities. Our sample included 66 studies. The majority of the studies investigated MAR outcomes by race/ethnicity and found that historically marginalized populations had poorer outcomes. LGBTQ + populations were less likely to use MAR or seek infertility care. Most studies found positive correlations with MAR use with income and education. The least commonly studied inequities in our sample were sex and/or gender and rural/under-resourced populations; findings showed that men and people from rural/under-resourced populations were less likely to access MAR. Studies that examined occupational status had varying findings. We suggest that future research be targeted toward: (1) standardizing and diversifying race/ethnicity reporting regarding MAR, (2) the use of community-based participatory research to increase data for LGBTQ + patients, and (3) increasing access to infertility care for men.
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Affiliation(s)
- Abbi Huddleston
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA.
| | - Kaylin Ray
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA
| | - Rigel Bacani
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA
| | - Jordan Staggs
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA
| | - Reece M Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17Th St, Tulsa, OK, 74107, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Tierney KI. Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis. J Assist Reprod Genet 2022; 39:2505-2519. [PMID: 36103005 PMCID: PMC9723016 DOI: 10.1007/s10815-022-02607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. METHODS Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. RESULTS At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. CONCLUSION There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.
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Affiliation(s)
- Katherine I Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI, 49008-5257, USA.
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8
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McKinnon CJ, Joglekar DJ, Hatch EE, Rothman KJ, Wesselink AK, Willis MD, Wang TR, Mikkelsen EM, Eisenberg ML, Wise LA. Male personal heat exposures and fecundability: A preconception cohort study. Andrology 2022; 10:1511-1521. [PMID: 35924639 PMCID: PMC9588744 DOI: 10.1111/andr.13242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies indicate adverse effects of selected heat exposures on semen quality, but few studies have directly evaluated fertility as an endpoint. OBJECTIVE We evaluated prospectively the association between male heat exposures and fecundability, the per-cycle probability of conception. MATERIALS AND METHODS We analyzed data from 3041 couples residing in the United States or Canada who enrolled in a prospective preconception cohort study (2013-2021). At enrollment, males reported on several heat-related exposures, such as use of saunas, hot baths, seat heaters, and tight-fitting underwear. Pregnancy status was updated on female follow-up questionnaires every 8 weeks until conception or a censoring event (initiation of fertility treatment, cessation of pregnancy attempts, withdrawal, loss to follow-up, or 12 cycles), whichever came first. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CIs) for the association between heat exposures and fecundability, mutually adjusting for heat exposures and other potential confounders. RESULTS We observed small inverse associations for hot bath/tub use (≥3 vs. 0 times/month: FR = 0.87, 95% CI: 0.70-1.07) and fever in the 3 months before baseline (FR = 0.94, 95% CI: 0.79-1.12; one cycle of follow-up: FR = 0.84, 95% CI: 0.64-1.11). Little association was found for sauna use, hours of laptop use on one's lap, seat heater use, time spent sitting, and use of tight-fitting underwear. Based on a cumulative heat metric, FRs for 1, 2, 3, and ≥4 versus 0 heat exposures were 0.99 (95% CI: 0.87-1.12), 1.03 (95% CI: 0.89-1.19), 0.94 (95% CI: 0.74-1.19), and 0.77 (95% CI: 0.50-1.17), respectively. Associations were stronger among men aged ≥30 years (≥4 vs. 0 heat exposures: FR = 0.60, 95% CI: 0.34-1.04). CONCLUSION Male use of hot tubs/baths and fever showed weak inverse associations with fecundability. Cumulative exposure to multiple heat sources was associated with a moderate reduction in fecundability, particularly among males aged ≥30 years.
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Affiliation(s)
- Craig J. McKinnon
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Dhruv J. Joglekar
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194 Research Triangle Park, North Carolina, 27709
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Mary D. Willis
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
| | - Ellen M. Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45 8200 Aarhus N, Denmark
| | - Michael L. Eisenberg
- Department of Urology and Obstetrics & Gynecology, Stanford University School of Medicine, 291 Campus Drive, Stanford, California
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, Massachusetts 02118
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Tierney K. The Future of Assisted Reproductive Technology Live Births in the United States. POPULATION RESEARCH AND POLICY REVIEW 2022; 41:2289-2309. [PMID: 35874801 PMCID: PMC9289087 DOI: 10.1007/s11113-022-09731-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI 49008-5257 USA
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Pathways to fatherhood: evaluating the priorities of self-identified gay and bisexual men pursuing family building options. F S Rep 2022; 3:91-99. [PMID: 35937454 PMCID: PMC9349239 DOI: 10.1016/j.xfre.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
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Acceptable, hopeful, and useful: development and mixed-method evaluation of an educational tool about reproductive options for people with sickle cell disease or trait. J Assist Reprod Genet 2022; 39:183-193. [PMID: 34806131 PMCID: PMC8866599 DOI: 10.1007/s10815-021-02358-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/12/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE People with sickle cell disease (SCD) or trait have many reproductive options, some of which decrease the chance of passing SCD to children, including in vitro fertilization with preimplantation genetic testing (IVF + PGT). Few are aware of these options, and educational materials are needed. This study aimed to develop an accessible, non-directive patient education material about reproductive options for those with SCD or trait via a process that incorporated stakeholders from the SCD community. METHODS Multidisciplinary stakeholders guided development and revision of a novel pamphlet. Researchers applied health literacy scales to measure pamphlet understandability. We interviewed nine patients with SCD and six multidisciplinary clinicians to evaluate the pamphlet. Interviews were recorded, transcribed, and coded by a five-member team who developed a codebook and proposed themes that were revised by all research team members. Feedback was incorporated into a revised pamphlet. RESULTS A two-page pamphlet describing reproductive options for people with SCD including IVF + PGT was acceptable to key stakeholders, including people with SCD. Material about this complex topic met health literacy standards, including being written at a 5th grade level. Patients reported feeling hopeful after reviewing the pamphlet, and participants considered the pamphlet useful, clear, and appropriate for distribution in clinics and online. CONCLUSIONS Though awareness of reproductive options for those with SCD or trait is low, patients and providers find a novel pamphlet about this topic acceptable and useful. Educational materials about complex topics including IVF + PGT can be written at a level understandable to the average American.
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Cerebral palsy in children born after assisted reproductive technology: a meta-analysis. World J Pediatr 2021; 17:364-374. [PMID: 34283367 DOI: 10.1007/s12519-021-00442-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several studies have assessed the association between cerebral palsy (CP) and assisted reproductive technology (ART), but the results remain controversial. We conducted a meta-analysis to evaluate the risk of CP after ART compared with natural conceptions and to examine CP risk separately in ART singletons, multiples and preterm births. METHODS Web-based databases (PubMed, Embase, the Cochrane Library, and Web of Science) were searched until November 22, 2020. Studies which compare CP rates after ART with natural conceptions were included. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. Effect estimates were extracted and combined using the fixed-effects or random-effects model depending on the heterogeneity test. RESULTS There were nine studies included in the meta-analysis. The included studies were of moderate or high quality. A significantly higher risk of CP [odds ratio (OR) = 2.17, 95% confidence interval (CI) 1.72-2.74] was found in ART children (n = 89,214) compared with naturally conceived children (n = 4,160,745). The significantly higher risk decreased when data were restricted to singletons (OR = 1.36, 95% CI 1.16-1.59) and disappeared when data were restricted to multiples (OR = 1.05, 95% CI 0.86-1.29) or preterm births (OR = 1.53, 95% CI 0.66-3.56). Subgroup and sensitivity analyses indicated that the overall results were robust. CONCLUSIONS The risk of CP is increased more than two-fold after ART. This increased risk is largely due to increased rates of multiple birth and preterm delivery in ART children.
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13
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Dicks N, Gutierrez K, Currin L, de Macedo MP, Glanzner WG, Mondadori RG, Michalak M, Agellon LB, Bordignon V. Tauroursodeoxycholic acid/TGR5 signaling promotes survival and early development of glucose-stressed porcine embryos†. Biol Reprod 2021; 105:76-86. [PMID: 33889948 PMCID: PMC8256098 DOI: 10.1093/biolre/ioab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 01/21/2023] Open
Abstract
Conditions of impaired energy and nutrient homeostasis, such as diabetes and obesity, are associated with infertility. Hyperglycemia increases endoplasmic reticulum stress as well as oxidative stress and reduces embryo development and quality. Oxidative stress also causes deoxyribonucleic acid damage, which impairs embryo quality and development. The natural bile acid tauroursodeoxycholic acid reduces endoplasmic reticulum stress and rescues developmentally incompetent late-cleaving embryos, as well as embryos subjected to nuclear stress, suggesting the endoplasmic reticulum stress response, or unfolded protein response, and the genome damage response are linked. Tauroursodeoxycholic acid acts via the Takeda-G-protein-receptor-5 to alleviate nuclear stress in embryos. To evaluate the role of tauroursodeoxycholic acid/Takeda-G-protein-receptor-5 signaling in embryo unfolded protein response, we used a model of glucose-induced endoplasmic reticulum stress. Embryo development was impaired by direct injection of tauroursodeoxycholic acid into parthenogenetically activated oocytes, whereas it was improved when tauroursodeoxycholic acid was added to the culture medium. Attenuation of the Takeda-G-protein-receptor-5 precluded the positive effect of tauroursodeoxycholic acid supplementation on development of parthenogenetically activated and fertilized embryos cultured under standard conditions and parthenogenetically activated embryos cultured with excess glucose. Moreover, attenuation of tauroursodeoxycholic acid/Takeda-G-protein-receptor-5 signaling induced endoplasmic reticulum stress, oxidative stress and cell survival genes, but decreased expression of pluripotency genes in parthenogenetically activated embryos cultured under excess glucose conditions. These data suggest that Takeda-G-protein-receptor-5 signaling pathways link the unfolded protein response and genome damage response. Furthermore, this study identifies Takeda-G-protein-receptor-5 signaling as a potential target for mitigating fertility issues caused by nutrient excess-associated blastomere stress and embryo death.
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Affiliation(s)
- Naomi Dicks
- Department of Animal Science, McGill University, Quebec, Canada
| | | | - Luke Currin
- Department of Animal Science, McGill University, Quebec, Canada
| | | | | | - Rafael G Mondadori
- Department of Animal Science, McGill University, Quebec, Canada
- ReproPel, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marek Michalak
- Department of Biochemistry, University of Alberta, Edmonton, Alberta, Canada
| | - Luis B Agellon
- School of Human Nutrition, McGill University, Quebec, Canada
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Younis JS, Iskander R, Fauser BCJM, Izhaki I. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update 2021; 26:904-928. [PMID: 32514566 DOI: 10.1093/humupd/dmaa013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population. OBJECTIVE AND RATIONALE The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21-35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes. SEARCH METHODS An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle-Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis. OUTCOMES Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21-27 days) was associated with lower ORT values as compared to normal (28-31 days), long (32-35 days) and all other (28-35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was -1.3 ng/mL (95% CI: -1.75 to -0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was -5.17 (95% CI: -5.96 to -4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72-0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of -1.8 oocytes (95% CI: -2.5 to -1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures. WIDER IMPLICATIONS MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel.,Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Safed, Israel
| | - Rula Iskander
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology, University of Utrecht and University Medical Center Utrecht, 3508 TC, Utrecht, The Netherlands
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa 3498838, Israel
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15
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Gulersen M, Peyser A, Ferraro A, Goldman R, Mullin C, Li X, Krantz D, Bornstein E, Rochelson B. Maternal and neonatal outcomes in pregnancies conceived after preimplantation genetic testing. Prenat Diagn 2021; 41:835-842. [PMID: 33773521 DOI: 10.1002/pd.5937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/01/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine whether preimplantation genetic testing (PGT) is associated with an increase in adverse maternal or neonatal outcomes in singleton and twin live births conceived via in vitro fertilization (IVF). METHOD Retrospective cohort of live births resulting from IVF within a university health system between January 2014 and August 2019. Adverse maternal outcomes (e.g., hypertensive disorders of pregnancy, abnormal placentation, and preterm birth), and adverse neonatal outcomes were compared in singleton and twin pregnancies conceived after transfer of one or two PGT-screened euploid embryos versus untested embryos in separate analyses. Multivariate backwards-stepwise logistic regression was used to adjust for potential confounders. RESULTS Of 1160 live births, 539 (46.5%) resulted from PGT-screened embryos, 1015 (87.5%) were singletons, and 145 (12.5%) were twins. After adjusting for potential confounders, there were no significant differences between the two groups with respect to hypertensive disorders of pregnancy, fetal growth restriction, preterm birth, and adverse neonatal outcomes in both analyses, as well as abnormal placentation for singletons. CONCLUSION Our data suggest that IVF with PGT is not associated with an increased risk of adverse maternal or neonatal outcomes compared to IVF without PGT. Further research utilizing larger cohorts are needed before drawing definitive conclusions.
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Affiliation(s)
- Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Alexandra Peyser
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Amanda Ferraro
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Randi Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Christine Mullin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Xueying Li
- Biostatistics, Eurofins NTD, Melville, New York, USA
| | - David Krantz
- Biostatistics, Eurofins NTD, Melville, New York, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital-Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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Evaluating the unevaluated: a secondary analysis of the National Survey for Family Growth (NSFG) examining infertile women who did not access care. J Assist Reprod Genet 2021; 38:1071-1076. [PMID: 33745082 DOI: 10.1007/s10815-021-02149-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To characterize the demographic differences between infertile/sub-fertile women who utilized infertility services vs. those that do not. METHODS A retrospective analysis of cross-sectional data obtained during the 2011-2013, 2013-2015, and 2015-2017 cycles of National Survey for Family Growth from interviews administered in home for randomly selected participants by a National Center of Health Statistics (NCHS) surveyor was used to analyze married, divorced, or women with long-term partners who reported difficulty having biological children (sub-fertile/infertile women). Demographic differences such as formal marital status, education, race, and religion were compared between women who presented for infertility care vs. those that did not. The primary outcome measure was presenting for infertility evaluation and subsequently utilizing infertility services. Healthcare utilization trends such as having a usual place of care and insurance status were also included as exposures of interest in the analysis. RESULTS Of the 12,456 women included in the analysis 1770 (15.3%) had used infertility services and 1011 (8.3%) said it would be difficult for them to have a child but had not accessed infertility services. On univariate analysis, compared to women who used infertility services, untreated women had lower average household incomes (295.3 vs. 229.8% of the federal poverty line respectively). Untreated women also had lower levels of education and were more likely to be divorced or never have married. In terms of health status, unevaluated women were less likely to have a usual place for healthcare (87.3%) as compared to women presenting for fertility care (91.9%) (p = 0.004). When examining insurance status, 23.3% of unevaluated women were uninsured as compared to 8.3% of evaluated women. On multivariate analysis, infertile women without insurance were at 0.37 odds of utilizing infertility care compared to women with insurance. CONCLUSIONS Demographic factors are associated with the utilization of infertility care. Insurance status is a significant predictor of whether or not infertile women will access treatment. Data from the three most recent NSFG surveys along with prior analyses demonstrate the need for expanded insurance coverage in order to address the socioeconomic disparities between infertile women who are accessing services vs. those that are not.
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17
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Passet-Wittig J, Greil AL. Factors associated with medical help-seeking for infertility in developed countries: A narrative review of recent literature. Soc Sci Med 2021; 277:113782. [PMID: 33895708 DOI: 10.1016/j.socscimed.2021.113782] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
The reasons why people decide for or against seeking medical help for infertility are still far from clear. With advances in reproductive medicine, use of medically-assisted reproduction has increased over the last three decades. Over the same period, an appreciable amount of quantitative studies on the determinants of medical help-seeking for infertility has accumulated. However, to our knowledge this narrative review is the first to summarize and evaluate findings from these studies. This review includes 39 studies carried out in 11 countries, covering the period 1990-2019. We have identified five categories of determinants of help-seeking: socio-demographic variables, socio-economic factors, reproductive history, attitudes, and psychological factors. Each category consists of several variables. Considerable knowledge has accumulated on socio-economic variables, indicating that there is social inequality in access to treatments in several countries. Less is known about marital status, attitudes and psychological factors. Findings on the latter two mostly derive from two US surveys. Overall, the body of research appears heterogeneous and fragmented. Studies differ in central aspects of study design (definitions of the analysis sample and of help-seeking, type of analysis (bivariate or multivariate), set of variables included in multivariate studies) making comparisons of findings difficult. Low comparability is reinforced by country differences in the provision of treatment, legislation on access and treatment coverage. The majority of papers lack a theoretical foundation or reference to any theory. Using a theoretical framework to guide empirical research could help to overcome the problems described above. Single-country studies should include information on legal and cultural context. More studies from countries other than the US are needed as well as multi-country studies in order to develop a systematic understanding of how macro-level structures relate to decisions about medical help-seeking. This review should assist future researchers in their attempt to conduct studies on help-seeking for infertility.
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Affiliation(s)
- Jasmin Passet-Wittig
- Federal Institute for Population Research, Friedrich-Ebert-Allee 4, 65185, Wiesbaden, Germany.
| | - Arthur L Greil
- Liberal Arts & Sciences, 1 Saxon Drive, Alfred, NY, 14802, Alfred University, USA.
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18
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Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol 2020; 17:718-731. [PMID: 32518358 DOI: 10.1038/s41569-020-0390-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
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19
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Wang L, Lv S, Mao W, Bai E, Yang X. Fecundity disorders in older women: declines in follicular development and endometrial receptivity. BMC WOMENS HEALTH 2020; 20:115. [PMID: 32487204 PMCID: PMC7268486 DOI: 10.1186/s12905-020-00979-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/24/2020] [Indexed: 02/07/2023]
Abstract
Background Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.
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Affiliation(s)
- Li Wang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shulan Lv
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenjun Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - E Bai
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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20
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Elder P, Sharma G, Gulati M, Michos ED. Identification of female-specific risk enhancers throughout the lifespan of women to improve cardiovascular disease prevention. Am J Prev Cardiol 2020; 2:100028. [PMID: 34327455 PMCID: PMC8315406 DOI: 10.1016/j.ajpc.2020.100028] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in women in the United States and globally, with heart disease actually on the rise among middle-aged women in the United States. This disease burden can be reduced by prioritizing a preventive approach to cardiovascular health. The 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Primary Prevention of CVD contains important updates for delivery of primary prevention and also highlights early menopause and pre-eclampsia as two female-specific risk factors that enhance CVD risk. Additionally other female-specific risk factors including early menarche, polycystic ovarian syndrome, multi-parity, other adverse pregnancy outcomes, and hormone therapy also influence women's CVD risk throughout their lifespan. It is vital that both women and healthcare clinicians are made aware of this information as it has lifesaving potential. This review aims to (1) Introduce the key points of the 2019 ACC/AHA Guideline (2) Highlight the evidence for the female-specific risk factors for refining CVD risk assessment and (3) Discuss the impact of the female-specific risk enhancing factors on primary prevention interventions such as statin therapy. This approach will be able to more personalize risk assessment in women, with an emphasis on the importance of shared decision making in building authentic partnerships between clinicians and women patients throughout their lifespan.
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Affiliation(s)
- Petal Elder
- Department of Medicine, University of Massachusetts Medical School, Baystate Health, Springfield, MA, USA
| | - Garima Sharma
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Erin D. Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
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21
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Sang Q, Zhang Z, Shi J, Sun X, Li B, Yan Z, Xue S, Ai A, Lyu Q, Li W, Zhang J, Wu L, Mao X, Chen B, Mu J, Li Q, Du J, Sun Q, Jin L, He L, Zhu S, Kuang Y, Wang L. A pannexin 1 channelopathy causes human oocyte death. Sci Transl Med 2020; 11:11/485/eaav8731. [PMID: 30918116 DOI: 10.1126/scitranslmed.aav8731] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/14/2019] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
Connexins and pannexins are two protein families that play an important role in cellular communication. Pannexin 1 (PANX1), one of the members of pannexin family, is a channel protein. It is glycosylated and forms three species, GLY0, GLY1, and GLY2. Here, we describe four independent families in which mutations in PANX1 cause familial or sporadic female infertility via a phenotype that we term "oocyte death." The mutations, which are associated with oocyte death, alter the PANX1 glycosylation pattern, influence the subcellular localization of PANX1 in cultured cells, and result in aberrant PANX1 channel activity, ATP release in oocytes, and mutant PANX1 GLY1. Overexpression of a patient-derived mutation in mice causes infertility, recapitulating the human oocyte death phenotype. Our findings demonstrate the critical role of PANX1 in human oocyte development, provide a genetic explanation for a subtype of infertility, and suggest a potential target for therapeutic intervention for this disease.
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Affiliation(s)
- Qing Sang
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China.
| | - Zhihua Zhang
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Juanzi Shi
- Reproductive Medicine Center, Shaanxi Maternal and Child Care Service Center, Shaanxi 710069, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
| | - Bin Li
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Zheng Yan
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Songguo Xue
- Reproductive Medicine Center, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 2000120, China
| | - Ai Ai
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Qifeng Lyu
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Wei Li
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Jilin Zhang
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ling Wu
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xiaoyan Mao
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Biaobang Chen
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Jian Mu
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Qiaoli Li
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Jing Du
- Shanghai Institute of Planned Parenthood Research, Shanghai 200011, China
| | - Qiang Sun
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Li Jin
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China
| | - Lin He
- Bio-X Center, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shujia Zhu
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yanping Kuang
- Reproductive Medicine Center, Shanghai Ninth Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.
| | - Lei Wang
- Zhongshan Hospital, State Key Laboratory of Genetic Engineering, Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China. .,Shanghai Center for Women and Children's Health, Shanghai 200062, China
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Tierney K, Cai Y. Assisted reproductive technology use in the United States: a population assessment. Fertil Steril 2019; 112:1136-1143.e4. [PMID: 31843090 PMCID: PMC6986780 DOI: 10.1016/j.fertnstert.2019.07.1323] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States. DESIGN Population-based study. SETTING Not applicable. PATIENT(S) Women 15-49 years old in the American Community Survey and National Vital Statistics Birth Certificate data from 2010-2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Birth rate after ART by major sociodemographic categories and likelihood of having an ART birth. RESULT(S) Net of education, age, period, and marital status, the incidence rates of ART births are lower for black women (0.57 times; 95% CI, 0.52-0.62) and Hispanic women (0.67 times; 95% CI, 0.57-0.62) relative to white women's rates; for Asian women, the incidence rates are 1.21 times that of white women's rates. Further, the incidence rates of ART births are higher for women with more than a 4-year degree (2.08 times; 95% CI, 1.90-2.27) relative to women with a 4-year degree, and are lower for women with less education. Women who are married have an incidence rate of ART that is 5.72 times (95% CI, 5.37-6.09) that of unmarried women. The incidence rates for 2013-2016 are statistically significantly higher than for 2010 by a factor of 1.16 (95% CI, 1.02-1.31), 1.16 (95% CI, 1.03-1.31), 1.27 (95% CI, 1.12-1.43), and 1.51 (95% CI, 1.43-1.82), respectively. The educational differences in ART exist across all age groups from 20 to 49, but are the largest among the 35-39 and 40-44 age groups. CONCLUSION(S) Large differences in the risk of an ART birth and the proportion of births and the total fertility rate due to ART exist across period, age, race, education, and marital status groups in the United States. Current measures of ART births may disguise an unmet need for ART.
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Affiliation(s)
- Katherine Tierney
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Yong Cai
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stevenson EL, Cebert M, Silva S. Stress and Anxiety in Couples Who Conceive via In Vitro Fertilization Compared With Those Who Conceive Spontaneously. J Obstet Gynecol Neonatal Nurs 2019; 48:635-644. [PMID: 31614109 DOI: 10.1016/j.jogn.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To determine the feasibility of recruitment and explore whether women and their partners who conceive via in vitro fertilization (IVF) experience greater levels of stress and anxiety during pregnancy compared to each other and compared to couples who conceive spontaneously. DESIGN Longitudinal, descriptive, pilot study. SETTING Recruitment was conducted at three sites in the United States (two fertility clinics and one well-woman clinic). PARTICIPANTS Informed consent was obtained from 48 women and their partners (22 IVF couples and 26 spontaneous conception [SC] couples). METHODS During each trimester, participants completed the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the Pregnancy-Related Anxiety Measure to assess their levels of stress and anxiety. We used hierarchical linear mixed-effects models for repeated measures adjusting for woman and partner nesting effects to conduct trajectory analyses to test for group differences in stress and anxiety levels. RESULTS Recruitment goals were met (31 IVF and 27 SC couples gave informed consent and 22 IVF and 26 SC couples completed questionnaires). We found no significant group main or group by time interaction effects on anxiety and stress. However, pregnant women had significantly higher mean state and pregnancy-related anxiety scores than their male partners. Of interest, the women showed a gradual reduction in state and pregnancy-related anxiety across trimesters, whereas pregnancy-related anxiety of their partners gradually increased. CONCLUSION Among our participants, IVF did not increase risk for stress, state anxiety, or pregnancy-related anxiety, which provides reassurance during patient counseling. Although pregnant women overall experienced greater state and pregnancy-related anxiety than men, we found that levels in women decreased closer to birth, which may contribute to successful emotional transition to parenthood. Men's experiences with anxiety require additional investigation given the recent attention to male postpartum depression.
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Gianfrilli D, Ferlin A, Isidori AM, Garolla A, Maggi M, Pivonello R, Santi D, Sansone A, Balercia G, Granata ARM, Sinisi A, Lanfranco F, Pasqualetti P, Foresta C, Lenzi A. Risk behaviours and alcohol in adolescence are negatively associated with testicular volume: results from the Amico‐Andrologo survey. Andrology 2019; 7:769-777. [DOI: 10.1111/andr.12659] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 01/06/2023]
Affiliation(s)
- D. Gianfrilli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology Sapienza University of Rome Rome Italy
| | - A. Ferlin
- Department of Clinical and Experimental Sciences Unit of Endocrinology and Metabolism University of Brescia Brescia Italy
| | - A. M. Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology Sapienza University of Rome Rome Italy
| | - A. Garolla
- Unit of Andrology and Reproductive Medicine Department of Medicine University of Padova Padova Italy
| | - M. Maggi
- Sexual Medicine and Andrology Dipartimento Scienze Biomediche Sperimentali e Cliniche ‘Mario Serio’ University of Florence Firenze Italy
| | - R. Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia Università Federico II di Napoli Naples Italy
| | - D. Santi
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - A. Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology Sapienza University of Rome Rome Italy
| | - G. Balercia
- Endocrinology, Department of Clinical and Molecular Sciences Polytechnic University of Marche Ancona Italy
| | - A. R. M. Granata
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - A. Sinisi
- Andrology Unit Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University HospitalL. Vanvitelli University of Campania Naples Italy
| | - F. Lanfranco
- Andrology Unit Division of Endocrinology, Diabetology and Metabolism Department of Medical Sciences University of Turin Torino Italy
| | - P. Pasqualetti
- Service of Medical Statistics and Information Technology Fatebenefratelli Foundation for Health Research and Education Rome Italy
| | - C. Foresta
- Unit of Andrology and Reproductive Medicine Department of Medicine University of Padova Padova Italy
| | - A. Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology Sapienza University of Rome Rome Italy
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25
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Almasi-Hashiani A, Omani-Samani R, Mohammadi M, Amini P, Navid B, Alizadeh A, Khedmati Morasae E, Maroufizadeh S. Assisted reproductive technology and the risk of preeclampsia: an updated systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:149. [PMID: 31046710 PMCID: PMC6498659 DOI: 10.1186/s12884-019-2291-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/12/2019] [Indexed: 11/22/2022] Open
Abstract
Background The objective of this systematic review and meta-analyses was to assess the risk of preeclampsia among women who conceived with assisted reproductive technology (ART). Methods We searched the ISI Web of Knowledge, Medline/PubMed, Scopus, and Embase (from inception to May 2017) for English language articles using a list of key words. In addition, reference lists from identified studies and relevant review articles were also searched. Data extraction was performed by two authors, and the study quality was assessed using the Newcastle–Ottawa Scale. Random-effects model meta-analysis was applied to pool the relative risks (RR) across studies. Results A total of 48 studies (5 case-control studies and 43 cohort studies) were included in this meta-analysis. The Cochran Q test and I2 statistics revealed substantial heterogeneity (Q = 26,313.92, d.f. = 47, p < 0.001 and I2 = 99.8%). Meta-analysis showed a significant increase in preeclampsia in women who conceived by ART compared with those who conceived spontaneously (RR = 1.71, 95% CI = 1.11–2.62, p = 0.015). Conclusions The findings of this systematic review indicate that the use of ART treatment is associated with a 1.71-fold increase in preeclampsia.
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Affiliation(s)
- Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Maryam Mohammadi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Payam Amini
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behnaz Navid
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Institute of Psychology, Health, and Society, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
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26
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Silva SGD, Bertoldi AD, Silveira MFD, Domingues MR, Evenson KR, Santos ISD. Assisted reproductive technology: prevalence and associated factors in Southern Brazil. Rev Saude Publica 2019; 53:13. [PMID: 30726494 PMCID: PMC6390642 DOI: 10.11606/s1518-8787.2019053000737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/06/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE: To assess the prevalence of successful assisted reproductive technology and to identify the associated factors. METHODS: This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression. RESULTS: Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology. CONCLUSIONS: The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.
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Affiliation(s)
- Shana Ginar da Silva
- Universidade Federal de Pelotas. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Mariângela Freitas da Silveira
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Marlos Rodrigues Domingues
- Universidade Federal de Pelotas. Escola Superior de Educação Física. Departamento de Desportos. Programa de Pós-Graduação em Educação Física. Pelotas, RS, Brasil
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill. Gillings School of Global Public Health. Department of Epidemiology. NC, United States
| | - Iná Silva Dos Santos
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
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27
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Farquhar CM, Bhattacharya S, Repping S, Mastenbroek S, Kamath MS, Marjoribanks J, Boivin J. Female subfertility. Nat Rev Dis Primers 2019; 5:7. [PMID: 30679436 DOI: 10.1038/s41572-018-0058-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subfertility is common and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations, as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm count, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, a greater awareness of lifestyle factors and a possible refinement of current assisted reproduction techniques and the development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ cell manipulation, artificial gametes, genetic screening of embryos and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries and a reduction in the current disparity of access to fertility care.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
| | - Siladitya Bhattacharya
- College of Biomedical and Life Sciences, Cardiff University School of Medicine, Cardiff, UK
| | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Jane Marjoribanks
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Jacky Boivin
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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28
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Arias-Sosa LA. Understanding the Role of Telomere Dynamics in Normal and Dysfunctional Human Reproduction. Reprod Sci 2018; 26:6-17. [DOI: 10.1177/1933719118804409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luis Alejandro Arias-Sosa
- Universidad Pedagógica y Tecnológica de Colombia, School of Biological Science, Tunja, Boyacá, Colombia
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29
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Cheng CY, Stevenson EL, Yang CT, Liou SR. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment. J Obstet Gynecol Neonatal Nurs 2018; 47:498-508. [DOI: 10.1016/j.jogn.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 01/29/2023] Open
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30
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Rumbold AR, Moore VM, Whitrow MJ, Oswald TK, Moran LJ, Fernandez RC, Barnhart KT, Davies MJ. The impact of specific fertility treatments on cognitive development in childhood and adolescence: a systematic review. Hum Reprod 2018; 32:1489-1507. [PMID: 28472417 DOI: 10.1093/humrep/dex085] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 04/05/2017] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Does fertility treatment influence cognitive ability in school aged children, and does the impact vary with the type of treatment? SUMMARY ANSWER The available high-quality evidence indicates that specific treatments may give rise to different effects on cognitive development, with certain treatments, including ICSI, associated with cognitive impairment. WHAT IS KNOWN ALREADY Previous reviews of the literature concerning cognitive outcomes among children conceived with medical assistance have concluded that study findings are generally 'reassuring', but limited attention has been paid to the quality of this research. In addition, no review has separately assessed the range of treatment modalities available, which vary in invasiveness, and thus, potentially, in their effects on developmental outcomes. STUDY DESIGN, SIZE, DURATION A systematic review was undertaken. We searched PubMed, PsycINFO and the Educational Resources Information Centre database to identify English-language studies published up until 21 November 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Two authors independently reviewed identified articles, extracted data and assessed study quality. Studies were eligible if they assessed cognitive development from age 4 years or more, among children conceived with fertility treatment compared with either children conceived naturally or children born from a different type of fertility treatment. Where available, data were extracted and reported separately according to the various components of treatment (e.g. mode of fertilization, embryo freezing, etc.). Risk of bias was assessed using the Newcastle-Ottawa Scale, with a score ≥7/9 indicative of high quality. MAIN RESULTS AND THE ROLE OF CHANCE The search identified 861 articles, of which 35 were included. Of these, seven were rated high quality. Most studies (n = 22) were subject to selection bias, due to the exclusion of children at increased risk of cognitive impairment. Among high-quality studies, there was no difference in cognitive outcomes among children conceived with conventional IVF and those conceived naturally. Findings among high-quality studies of children conceived with ICSI were inconsistent: when compared with children conceived naturally, one study reported lower intelligence quotient (IQ; 5-7 points, on average) among ICSI children whereas the remaining two high-quality studies reported no difference between groups. Furthermore, among the three high-quality studies comparing children conceived with ICSI compared with conventional IVF, one reported a significant increase in the risk of mental retardation, one reported a small difference in IQ (3 points lower, on average) and one no difference at all. There were scant studies examining exposure to embryo freezing, or less invasive treatments such as ovulation induction without IVF/ICSI. LIMITATION, REASONS FOR CAUTION Most existing studies had methodological limitations including selection bias and/or failure to address confounding by family background. In addition, a meta-analysis could not be performed due to heterogeneity in the assessment of cognitive outcomes. These factors impeded our ability to synthesize the evidence and draw reliable conclusions. WIDER IMPLICATIONS OF THE FINDINGS The conflicting findings among studies of children conceived with ICSI require clarification, in light of the increasing use of this technique for reasons other than male-factor infertility. Further population-based studies are needed that utilize contemporary data to examine specific aspects of treatment and combinations of techniques (e.g. ICSI with frozen embryo cycles). Importantly, studies should include the complete group of children exposed to treatment. STUDY FUNDING/COMPETING INTEREST(S) A.R.R. is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia. L.J.M. is funded by a fellowship from the Heart Foundation of Australia. The authors declare there are no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Alice R Rumbold
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Vivienne M Moore
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.,School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Melissa J Whitrow
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.,School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Tassia K Oswald
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.,School of Psychology, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Lisa J Moran
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.,Monash Centre for Health Research Implementation, Monash University, Melbourne, Victoria 3163, Australia
| | - Renae C Fernandez
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia.,School of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michael J Davies
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia 5005, Australia
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Tweed S, Bhattacharya S, Fowler PA. Effects of maternal smoking on offspring reproductive outcomes: an intergenerational study in the North East of Scotland. Hum Reprod Open 2017; 2017:hox006. [PMID: 30895224 PMCID: PMC6276687 DOI: 10.1093/hropen/hox006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/03/2017] [Accepted: 05/13/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION How does exposure to cigarette smoke in utero influence women's reproductive outcomes? SUMMARY ANSWER Women exposed to cigarette smoke in utero were more likely to have a pregnancy and more likely to experience miscarriage. WHAT IS ALREADY KNOWN Existing epidemiological studies have been inconsistent, but generally suggest a small decrease in fertility of women exposed to cigarette smoke in utero. STUDY DESIGN, SIZE, DURATION This cohort study included all women born prior to 31st December 1972 as recorded in the Aberdeen Maternity and Neonatal Databank. Exposure to maternal cigarette smoking in utero was retrieved from their birth records within the database. The primary outcome was any pregnancy occurring in the offspring over the course of their reproductive life. The 12 321 eligible women were followed up for 40 years for any pregnancies and the outcome of those pregnancies recorded in the same database. PARTICIPANTS/MATERIALS, SETTING, METHODS Within the cohort, 3836 women were exposed to cigarette smoke and 8485 women were not exposed to cigarette smoke in utero. Generalized estimating equations were used to generate odds ratios (OR) and 95% CIs for all outcomes with adjustment made for all differences between groups at baseline. MAIN RESULTS AND THE ROLE OF CHANCE The study did not find a link between exposure to cigarette smoke in utero and a decrease in fertility. Women exposed to cigarette smoke in utero were more likely to have a pregnancy than those whose mother did not smoke; adjusted OR = 1.25 (95% CIs: 1.13–1.38). Women exposed to cigarette smoke in utero were also likely to have a pregnancy earlier (adjusted OR for age at first delivery ≤19 years 1.31 [95% CIs: 1.12–1.54)] than those not exposed. Women exposed to cigarette smoke in utero were significantly more likely to have a miscarriage than those not exposed; adjusted OR = 1.16 (95% CIs: 1.01–1.32). LIMITATIONS, REASONS FOR CAUTION Although the cohort in this study was large, there were women for whom exposure data was unavailable. Data on the adult circumstances of women who did not record a pregnancy was unavailable, precluding adjustment for their own smoking status or social class. In addition, women who migrated from the area or chose childlessness voluntarily were not included in the study. WIDER IMPLICATIONS OF THE FINDINGS Despite the wide-ranging harmful effects of cigarette smoke on foetal reproductive development, the effect at a population level remains uncertain. An increased risk of miscarriage in women exposed to cigarette smoke is a potentially important novel finding, which should be investigated further. This study illustrates the lack of consensus on the reproductive effects of in utero cigarette exposure, compelling continuing study in this important area. STUDY FUNDING/COMPETING INTEREST(S) No funding received. No competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sam Tweed
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Sohinee Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Paul A Fowler
- Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
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32
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Udell JA, Lu H, Redelmeier DA. Failure of fertility therapy and subsequent adverse cardiovascular events. CMAJ 2017; 189:E391-E397. [PMID: 28385819 DOI: 10.1503/cmaj.160744] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Infertility may indicate an underlying predisposition toward premature cardiovascular disease, yet little is known about potential long-term cardiovascular events following fertility therapy. We investigated whether failure of fertility therapy is associated with subsequent adverse cardiovascular events. METHODS We performed a population-based cohort analysis of women who received gonadotropin-based fertility therapy between Apr. 1, 1993, and Mar. 31, 2011, distinguishing those who subsequently gave birth and those who did not. Using multivariable Poisson regression models, we estimated the relative rate ratio of adverse cardiovascular events associated with fertility therapy failure, accounting for age, year, baseline risk factors, health care history and number of fertility cycles. The primary outcome was subsequent treatment for nonfatal coronary ischemia, stroke, transient ischemic attack, heart failure or thromboembolism. RESULTS Of 28 442 women who received fertility therapy, 9349 (32.9%) subsequently gave birth and 19 093 (67.1%) did not. The median number of fertility treatments was 3 (interquartile range 1-5). We identified 2686 cardiovascular events over a median 8.4 years of follow-up. The annual rate of cardiovascular events was 19% higher among women who did not give birth after fertility therapy than among those who did (1.08 v. 0.91 per 100 patient-years, p < 0.001), equivalent to a 21% relative increase in the annual rate (95% confidence interval 13%-30%). We observed no association between event rates and number of treatment cycles. INTERPRETATION Fertility therapy failure was associated with an increased risk of long-term adverse cardiovascular events. These women merit surveillance for subsequent cardiovascular events.
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Affiliation(s)
- Jacob A Udell
- Women's College Hospital and Toronto General Hospital (Udell), University of Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute, Toronto, Ont.
| | - Hong Lu
- Women's College Hospital and Toronto General Hospital (Udell), University of Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute, Toronto, Ont
| | - Donald A Redelmeier
- Women's College Hospital and Toronto General Hospital (Udell), University of Toronto; Institute for Clinical Evaluative Sciences (Udell, Lu); Department of Medicine (Redelmeier), Sunnybrook Health Sciences Centre, University of Toronto; Evaluative Clinical Sciences (Redelmeier), Sunnybrook Research Institute, Toronto, Ont
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Stevenson EL, Sloane R. Certain Less Invasive Infertility Treatments Associated with Different Levels of Pregnancy-Related Anxiety in Pregnancies Conceived via In Vitro Fertilization. J Reprod Infertil 2017; 18:190-196. [PMID: 28377899 PMCID: PMC5359857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Research supports that in vitro fertilization causes anxiety and that anxiety can continue into the resulting pregnancy. Most women who have IVF will have a less invasive treatment for infertility prior to IVF; however, it is unclear if specific less invasive treatment cycles impact anxiety that is experienced in the pregnancy resulting from IVF. METHODS A prospective study was conducted for women who became pregnant via IVF, and data was collected about reported previous non-IVF treatment cycles as well as Pregnancy Related Anxiety Measure. Latent Class Analysis was conducted A p-value of ≤0.05 was considered significant. RESULTS 144 subjects participated and were highly educated, affluent, married, and primarily white. The LCA process yielded two groups that on average had similar levels on most items except for use of intra uterine insemination and/or ovarian stimulation. This information was used to generate four exhaustive and mutually exclusive groups: Stimulation Only (stim-only), Stimulation and Intra uterine Insemination (stim-IUI), Intra uterine Insemination only (IUI only), or No Treatment (No Tx). ANOVA found that those in the Stim Only group had statistically significantly higher PRAM scores than the Stim IUI (p=0.0036), the IUI only group (p=0.05), and the No Tx group (p=0.0013). CONCLUSION Women who become pregnant via IVF and had a history of non-in vitro fertilization cycles that only involved ovarian stimulation experienced more pregnancy-specific anxiety in the pregnancy that results from in vitro fertilization.
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Affiliation(s)
- Eleanor Lowndes Stevenson
- Division of Health for Women, Children and Families, School of Nursing, Duke University, Durham, USA,Corresponding Author: Eleanor L Stevenson, Division of Health for Women, Children and Families, School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, USA E-mail:
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Vo H, Cheng D, Cheng TL, Mistry KB. Health Behaviors Among Women Using Fertility Treatment. Matern Child Health J 2016; 20:2328-2335. [PMID: 27473090 DOI: 10.1007/s10995-016-2056-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe associated perinatal behaviors among women using fertility treatment. Methods Data were obtained for 12,197 Maryland women who delivered live neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey postpartum. We conducted weighted descriptive and multivariable analyses. Results Among 1368 women using fertility treatments, 28.4 % did not take folic acid daily 1 month before pregnancy, 58.1 % consumed alcohol, 16.0 % were binge drinking, and 7.5 % smoked 3 months before pregnancy, and 12.9 % consumed alcohol and 3.7 % smoked during pregnancy. Additionally, among those who consumed alcohol and smoked before pregnancy, 36.0 % and 25.7 %, respectively, reported not receiving prenatal counseling about alcohol use and smoking. Lack of counseling for these women was higher than for women with unintended pregnancies who consumed alcohol (36.0 % vs. 26.3 %, P < .001) or smoked (25.7 % vs. 15.0 %, P < .001). Women using fertility treatments were less likely to have inadequate folic acid intake [adjusted odds ratio (aOR) 0.14, 95 % confidence interval (CI) 0.10-0.18), consume alcohol (aOR 0.52, 95 % CI 0.40-0.69), and smoke (aOR 0.35, 95 % CI 0.21-0.59) before pregnancy, and no statistically significant differences were found during pregnancy for alcohol consumption (aOR 0.89, 95 % CI 0.59-1.33) or smoking (aOR 0.64, 95 % CI 0.28-1.45) compared to women with unintended pregnancies. Conclusion A significant proportion of women using fertility treatments were not practicing recommended perinatal behaviors or receiving prenatal counseling on preventable risk factors. Ongoing counseling before and during pregnancy may be especially effective for optimizing healthy behaviors among these motivated women undergoing often stressful treatments for fertility.
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Affiliation(s)
- Holly Vo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,University of California, San Diego School of Medicine, 9500 Gilman Drive MC 0606, La Jolla, CA, 92093, USA.
| | - Diana Cheng
- Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene, 201 W. Preston Street, Room 313, Baltimore, MD, 21201, USA
| | - Tina L Cheng
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street #8941, Baltimore, MD, 21287, USA
| | - Kamila B Mistry
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Agency for Healthcare Research and Quality, Office of Extramural Research, Education and Priority Populations, 5600 Fishers Lane, Room 06N03, Rockville, MD, 20857, USA
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